Abstract: A system for fully automating the administration of a health plan. The system accepts inputs from enrollees, insureds, providers, insurers and vendors, but requires no physical data entry from the plan administrator. The system also features an automated methodology that measures patient treatment outcomes in terms of quality-adjusted life-years, by diagnosis and by medical treatment provider. The system also includes automated methods for: a “just-in-time” appointment scheduler, an editable archive of prototypical treatment plans, measuring the diagnostic accuracy of diagnostic physicians and for measuring the complication rate of treatment providers.

Abstract: A system for administering a health care system, comprising up to five processing means and a database. The system accepts inputs from enrollees, insureds, providers, insurers and vendors, but requires no input from an administrator. The apparatus optionally includes devices for: measuring patient treatment outcomes, a “just-in-time” appointment rescheduler, an editable archive of prototypical treatment plans, measuring the diagnostic accuracy of diagnosing physicians and measuring the complication rate of treatment providers.

Abstract: An automated health benefit processing system. The system includes a database and three processors. The database includes, for each geographic area and for each medical procedures for which a benefit is payable, the benefit payable to an insured if the procedure is prescribed and performed, a list of providers available to perform the designated procedure, and each provider's charge for performing the designated procedure. The first processor generates a treatment plan concerning the insured that specifies the identity of the insured and the medical procedures to be performed on the insured. The first processor also accesses the database to retrieve the information stored in the database under the medical procedures to be performed and to append this information to the treatment plan. The second processor generates a treatment record specifying the medical procedures actually performed by a provider and the provider's actual charge therefor.

Abstract: An automated health benefit processing system. The system includes a database and three processors. The database includes, for each geographic area and for each medical procedures for which a benefit is payable, the benefit payable to an insured if the procedure is prescribed and performed, a list of providers available to perform the designated procedure, and each provider's charge for performing the designated procedure. The first processor generates a treatment plan concerning the insured that specifies the identity of the insured and the medical procedures to be performed on the insured. The first processor also accesses the database to retrieve the information stored in the database under the medical procedures to be performed and to append this information to the treatment plan. The second processor generates a treatment record specifying the medical procedures actually performed by a provider and the provider's actual charge therefor.